Frozen Shoulder

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Range of motion of shoulder

Niel-Asher Technique

Standard physiotherapy

Placebo treatment

Shoulder pain

Niel-Asher Technique

Standard physiotherapy

Placebo treatment

Strength & power

(measured by cybex dynamometer)

Niel-Asher Technique

Standard physiotherapy

Placebo treatment

-3.5

52.6˚

24.0˚ 0.8˚

80%

40% 45%

The Proof

In clinical trials at the Rheumatology Research Department at Addenbrookes Hospital, Cambridge, the Niel-Asher Technique was compared with standard physiotherapy and a placebo treatment. Each patient had six treatments over nine weeks.

The results of the study was

Frozen Shoulder

Frozen Shoulder Syndrome is an extremely painful and debilitating condition characterized by pain and stiffness of the shoulder. Now there is a proven, natural programme that works in months, not years, and has helped transform the life of thousands world-wide.

The Niel-Asher Technique® has been compared to standard physical therapy in a Randomised Placebo Controlled Trial, conducted in association with the Rheumatology Research Unit at Addenbrookes Hospital, Cambridge - UK. It showed an 80% decrease in pain, and a significant improvement in range of motion and strength and power over and above traditional physical therapy.

Michael is currently using the revolutionary Niel-Asher Technique for frozen shoulders and adhesive capsulitis. This technique is a solution to the devastatingly painful disability that results from frozen shoulders.

What is Frozen Shoulder?

Frozen shoulder or adhesive capsulitis, as it is sometimes called, is a syndrome that causes stiffness and pain in the shoulder. It reduces normal movement in the joint and in some cases can prevent movement in the shoulder altogether. Usually only one shoulder is affected, but in 1 in 5 cases the condition occurs in the other shoulder. Most cases of frozen shoulder effects the non-dominant shoulder (e.g. the left shoulder in a right handed person). People between the ages of 40 and 60 are at greater risk and it is more common in women than in men. Without treatment symptoms usually go, but this may take up to 2-3 years. Conventional treatments can ease pain and improve the movement of the shoulder but their effectiveness is limited and may still take 2 years to resolve the problem. The Niel-Asher Technique achieves in contrast a 90% to 100% improvement in most patients following course of 9 treatments and in less than 4 months.

The causes of frozen shoulder is not fully understood, although it is more common among people who have diabetes. Frozen shoulder is not related to arthritis and does not affect other joints in the body.

It was thought that scar tissue and inflammation form in the shoulder capsule (a thin layer of tissue that covers and protects the shoulder joint) may cause it to thicken, contract, and limit the movement of the shoulder. The reason why the scar tissue and inflammation formed was not known.

It is now thought that damage to the long bicep tendon that passes through the capsule of the shoulder may be the trigger. This is because when the body is developing in the womb the bicep tendon is formed within its protective sheath before the immune system has developed. This means that the two tissues have never been in contact with each other and therefore the immune system does not recognise the bicep tendon as belonging to the body. When the bicep tendon becomes injured or inflamed fluid from it can leak in to the shoulder capsule where it comes in to contact with the body's immune system. This results in a large cascade of inflammation as the immune system attacks what it considers to be foreign cells.

In response to the pain and inflammation in the shoulder, the subconscious part of the brain causes the muscles that control movement of the shoulder to contract in a different order. They start working against one another and thereby restrict movement of the joint in an attempt to protect it. This causes the freezing affect.

A frozen shoulder occasionally follows an obvious shoulder injury, but this is not usual and most cases occur gradually and cannot be attributed to any one event.

What causes Frozen Shoulder?

What are the symptoms?

The typical symptoms are pain, stiffness, and limitation in the range of movement of a shoulder. The symptoms typically have three phases.

Phase one - the 'freezing', painful phase. This typically lasts 2-9 months. The first symptom is usually pain. Stiffness and limitation of movement then also gradually build up. The pain is typically worse at night, and when lying on the affected side or can be a sharp catching pain on sudden movement or external rotation (reaching to the back seat of a car, changing gear or brushing your hair).
Phase two - the 'frozen', stiff phase. This typically lasts 4-12 months. Pain gradually eases but stiffness and limitation of movement remain and can get worse. All movements of the shoulder are affected but the movement most severely affected is usually rotation of the arm outwards. The muscles around the shoulder may waste slightly as they are not being used.
Phase three - the 'thawing', recovery phase. This typically lasts 5-24 months. The stiffness gradually goes and movement gradually returns to normal, or near normal.

Symptoms often interfere with everyday tasks such as driving, dressing, or sleeping. Even scratching your back or putting your hand in a rear pocket may become impossible. Work may be affected in some cases.

Who gets Frozen Shoulder?

Frozen shoulder affects about 1 in 20 adults at some stage in their life. It most commonly occurs in people aged between 40 and 60. It is more common in people who have diabetes. In about 1 in 5 cases the condition also develops in the other shoulder at some stage.

What are the treatment options for Frozen Shoulder?

The Niel-Asher Technique®

The Niel-Asher Technique® is a 'natural' method utilizing the body's own healing mechanisms. No drugs, no surgery. It is HANDS-ON-ONLY. It uses a specific and unique sequence of manipulations and pressure points to the shoulder joints and soft-tissues. In essence, these can be thought of as 'inputs' into the nervous system. This unique combination stimulates a new pathway in the brain, rapidly releasing injury and spasm and increasing strength and power. This theory is called Cortex-Neuro-Somatic-Programming® (CNSP®). The technique 'fools' the body/brain into healing itself by addressing the two main components of the problem - pain and stiffness. Initially the technique aims to significantly reduce the pain, by treating the swelling around various shoulder tendons (especially the long head biceps tendon). Following this, the technique moves on to rapidly defrost and improve the range of shoulder motion by stimulating a unique sequence of reflexes hidden within the muscles. This works on the parts of the brain that co-ordinate the shoulder muscles called the motor cortex. By using a unique choreographed sequence of reflexes one against another the brain is fooled into changing the fixed capsular pattern. We do not force the arm; instead you keep it still whilst we apply the pressure.

Anti-inflammatory painkillers

NSAID (non-steroidal anti-inflammatory drug) for example, ibuprofen, diclofenac, naproxen, etc are commonly prescribed to ease pain but there has been no placebo controlled clinical trials to verify their effectiveness. Side-effects such as stomach and gut disorders and asthma occur with anti-inflammatory painkillers. Always read the leaflet that comes with the drug packet for a full list of cautions and possible side-effects. There are many different brands, therefore, if one does not suit, another may be fine. Their effectiveness is limited and in many cases they have no effect on the symptoms.

Ordinary painkillers

Paracetamol or codeine may be an option if anti-inflammatory painkillers do not suit. These do not have any anti-inflammatory action, but are good painkillers. Constipation is a common side-effect from codeine. You can take painkillers in addition to other treatments. You must bear in mind that painkillers only mask symptoms and do not heal damaged tissues.

Manual therapy

Many people are referred to a physiotherapist who can give advice on exercises to use. Also, they may try other pain relieving techniques such as heat, cold, TENS machines, etc. This conventional treatment is mainly aimed at helping the patient cope until the process takes its course. It has little effect on the level of night pain or duration of the frozen shoulder. Physiotherapy can make some short term improvements but studies have shown there is no evidence of benefit to frozen shoulder (adhesive capsulitis) in the long term.

Shoulder exercises

These are commonly advised. The aim is to keep the shoulder from 'stiffening up', and to keep movement as full as possible. For most benefit, it is important to do the exercises regularly, as instructed by a therapist.

Steroid injections

A steroid injection into, or near to, the shoulder joint can in some cases bring relief of symptoms for several weeks. Steroids reduce inflammation but are not a 'cure' as symptoms tend to gradually return, but many people welcome the relief that a steroid injection can bring. The danger is that during the period that the symptoms are relived many patients forget that the shoulder is still injured and go back to using it as normal. The result of this is often the shoulder is permanently damaged and full use is never regained. The side effects of steroid injections must also be considered. Steroids cause damage to connective tissue, cartilage and tendons, and can affect insulin levels in diabetics.

Nerve block

This technique is an injection to block the nerves that send pain messages from the shoulder. In trials nerve block injections resulted in subjective reduction in pain but no change in mobility or function of the shoulder. Like a steroid injection, it can eases symptoms for a while, but it is not a 'cure'. As with steroid injections during the period that the symptoms are relived many patients forget that the shoulder is still injured and go back to using it as normal. The result of this is often the shoulder is permanently damaged and full use is never regained.

Surgery

An operation is sometimes considered if other treatments do not help. Techniques that are used include:

Manipulation Under Anaesthesia (MUA). This is a procedure where the shoulder is moved around by the surgeon while you are under anaesthetic. MUA is used less frequently these days as it can cause as many problems as it solves. Common complications are fractures of the humerus (upper arm bone), ruptured tendons and nerve damage.
Arthroscopic Capsular Release. This is a relatively small operation done as 'keyhole' surgery. It is often done as a day-case procedure. In this procedure the tight capsule of the joint is released with a special probe. This technique is more successful than MUA but may still result in nerve damage and bone injury.

Conclusion

Frozen shoulder syndrome is an extremely painful and debilitating condition characterized by pain and stiffness of the shoulder. Now there is a proven, natural programme (the Niel-Asher Technique) that works in months, not years, and has helped transform the life of thousands world-wide. Michael is a practitioner of the revolutionary Niel-Asher Technique for frozen shoulder. This technique is a solution to the devastatingly painful disability that results from frozen shoulders. "I was a little sceptical as to the claims made for the Niel-Asher Technique at first but having treated many patients using it and achieving great improvements with them I am convinced it is the best treatment available".